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Organizational Providers Credentialing Application Instructions This CREDENTIALING/CREDENTIALING APPLICATION is for Kaiser Permanent network organizational providers. Important disclaimer: Submission

How to fill out 2019-0816 provider applicationcredentialing-recredentialing application

How to fill out 2019-0816 provider applicationcredentialing-recredentialing application

1. Begin by downloading the 2019-0816 provider applicationcredentialing-recredentialing application form.
2. Fill out the applicant's personal information, including name, address, contact details, and social security number.
3. Provide details about the applicant's educational background, certifications, licenses, and any relevant professional experiences.
4. Complete the section related to the applicant's current practice, including employment history, clinic or hospital affiliations, and any malpractice claims.
5. Fill out the insurance information section, listing the applicant's current liability coverage and providing copies of relevant policies if required.
6. Include information about the applicant's current patients, including the number of active patients, average daily patient load, and specialties.
7. Complete the disclosure section, providing any relevant information about legal actions, criminal convictions, or disciplinary actions.
8. Attach any necessary supporting documents, such as curriculum vitae, copies of medical licenses, or recommendation letters.
9. Review the completed application thoroughly to ensure accuracy and completeness.
10. Submit the filled-out application along with any required fees or additional documents to the appropriate credentialing organization.

Who needs 2019-0816 provider applicationcredentialing-recredentialing application?

1. Healthcare providers, including physicians, dentists, nurses, therapists, and other medical professionals, who wish to apply for initial credentialing or recredentialing need to fill out the 2019-0816 provider applicationcredentialing-recredentialing application.

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What is 0816 provider application credentialing-recredentialing application?

The 0816 provider application credentialing-recredentialing application is a form used by healthcare providers to apply for and maintain their credentials with health plans and insurance companies. It ensures that providers meet the necessary qualifications to offer medical services.

Who is required to file 0816 provider application credentialing-recredentialing application?

Healthcare providers, including physicians, nurses, and allied health professionals, who wish to participate in health plans and receive reimbursements for their services are required to file the 0816 provider application credentialing-recredentialing application.

How to fill out 0816 provider application credentialing-recredentialing application?

To fill out the 0816 application, providers should gather all required personal and professional information, including education, licenses, work history, and references. Each section of the application must be completed accurately and thoroughly, and documents supporting the information provided should be attached as necessary.

What is the purpose of 0816 provider application credentialing-recredentialing application?

The purpose of the 0816 provider application credentialing-recredentialing application is to verify a provider's qualifications, credentials, and professional history to ensure they are eligible to deliver healthcare services and to maintain compliance with regulations set by health plans and governing bodies.

What information must be reported on 0816 provider application credentialing-recredentialing application?

The application requires detailed information, including the provider's personal identification details, professional education, training, licenses, certifications, work history, malpractice history, and any disciplinary actions taken against them.